The proposed study of Barriers to Mental Health Treatment in Primary Care requests one year B/Start funding to investigate the prevalence and impact of psychological barriers to mental health treatment, to treatment behaviors and to clinical outcome in older adults with depression in primary care. Inadequate treatment on major depression among older remains a significant public health concern, even though there is ample evidence that major depression can be effectively treated with pharmacotherapy in most elderly adults with depression (Hirschfeld et a., 1997 Schneider, 1996). Preliminary investigations suggest that psychological barriers, such as minimizing the need for treatment and perceived stigma, reported at the beginning of outpatient psychiatric treatment for depression can be important factors in predicting treatment behaviors such as medication recommendation, antidepressant adherence and treatment discontinuation (Sirey, et a., 1999, in press). The primary aims of this study are : 1) to assess the prevalence depression seen in primary care; 2) to examine the impact of psychological barriers on treatment initiation (either pharmacotherapy or non-pharmacologic interventions); and 3) to explore the relationship between psychological barriers and improvement in depressive symptoms. To address these aims the funding would be used to support the primary care (Prevention of Suicide in Primary Care Elderly: Collaborative Trial, PROSPECT; MH 59366; PI George S. Alexopoulos, M.D.). The proposed study would assess the psychological barriers reported by 60 Cornell site of the PROSPECT Study). A part of (PROSPECT) sample is re-interviewed four months later to assess: 1) treatment behaviors (e.g. initiation of treatment, services used); 2) depressive symptoms; and 3) review criteria for depression. Analyses examine the of barriers on treatment initiation, controlling for intervention status. Additional analyses will explore the impact of barriers on clinical status at follow-up.